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<div><p style="line-height:40pt; margin:0pt; orphans:0; text-align:center; widows:0"><span
        style="font-family:文星标宋; font-size:18pt; font-weight:bold">行政强制代履行完毕确认书</span><span
        style="font-family:宋体; font-size:10.5pt; font-weight:normal">                   </span><span
        style="font-family:宋体; font-size:12pt; font-weight:normal"> </span></p>
    <table cellspacing="0" cellpadding="0" style="border-collapse:collapse; margin-left:0pt">
        <tr style="height:24pt">
            <td rowspan="5"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:21.5pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">当事人</span></p></td>
            <td rowspan="3"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:25.3pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">法人</span></p>
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">或者</span></p>
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">其他</span></p>
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">组织</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:43.2pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">名</span><span
                        style="font-family:宋体; font-size:12pt">  </span><span
                        style="font-family:宋体; font-size:12pt">称</span></p></td>
            <td colspan="3"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:top; width:295.2pt">
                <p style="margin:0pt; orphans:0; text-align:justify; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
        </tr>
        <tr style="height:35.9pt">
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:43.2pt">
                <p style="line-height:12pt; margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">法</span><span
                        style="font-family:宋体; font-size:12pt">  </span><span
                        style="font-family:宋体; font-size:12pt">定</span></p>
                <p style="line-height:12pt; margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">代表人</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:top; width:160.2pt">
                <p style="line-height:12pt; margin:0pt; orphans:0; text-align:justify; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:46pt">
                <p style="line-height:12pt; margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">职</span><span
                        style="font-family:宋体; font-size:12pt">  </span><span
                        style="font-family:宋体; font-size:12pt">务</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:top; width:67.4pt">
                <p style="line-height:12pt; margin:0pt; orphans:0; text-align:justify; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
        </tr>
        <tr style="height:24pt">
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:43.2pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">地</span><span
                        style="font-family:宋体; font-size:12pt">  </span><span
                        style="font-family:宋体; font-size:12pt">址</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:top; width:160.2pt">
                <p style="margin:0pt; orphans:0; text-align:justify; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:46pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">电</span><span
                        style="font-family:宋体; font-size:12pt">  </span><span
                        style="font-family:宋体; font-size:12pt">话</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:top; width:67.4pt">
                <p style="margin:0pt; orphans:0; text-align:justify; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
        </tr>
        <tr style="height:29.6pt">
            <td rowspan="2"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:25.3pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">公民</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:43.2pt">
                <p style="line-height:12pt; margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">身份证号</span><span
                        style="font-family:宋体; font-size:12pt">  </span><span
                        style="font-family:宋体; font-size:12pt">码</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:top; width:160.2pt">
                <p style="line-height:12pt; margin:0pt; orphans:0; text-align:justify; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:46pt">
                <p style="line-height:12pt; margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">姓</span><span
                        style="font-family:宋体; font-size:12pt">  </span><span
                        style="font-family:宋体; font-size:12pt">名</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:top; width:67.4pt">
                <p style="line-height:12pt; margin:0pt; orphans:0; text-align:justify; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
        </tr>
        <tr style="height:24pt">
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:43.2pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">地</span><span
                        style="font-family:宋体; font-size:12pt">  </span><span
                        style="font-family:宋体; font-size:12pt">址</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:top; width:160.2pt">
                <p style="margin:0pt; orphans:0; text-align:justify; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:46pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">电</span><span
                        style="font-family:宋体; font-size:12pt">  </span><span
                        style="font-family:宋体; font-size:12pt">话</span></p></td>
            <td style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:top; width:67.4pt">
                <p style="margin:0pt; orphans:0; text-align:justify; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
        </tr>
        <tr style="height:35.25pt">
            <td colspan="2"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:57.6pt">
                <p style="line-height:12pt; margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">代履行决定书文号</span></p></td>
            <td colspan="4"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:349.2pt">
                <p style="line-height:23pt; margin:0pt; orphans:0; text-align:justify; text-indent:31.5pt; widows:0">
                    <span style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
        </tr>
        <tr style="height:24pt">
            <td colspan="2"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:57.6pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">代履行</span><span
                        style="font-family:宋体; font-size:12pt">  </span><span
                        style="font-family:宋体; font-size:12pt">时间</span></p></td>
            <td colspan="4"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:349.2pt">
                <p style="margin:0pt; orphans:0; text-align:justify; text-indent:31.5pt; widows:0"><span
                        style="font-family:宋体; font-size:12pt">年</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">月</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">日</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">时</span><span
                        style="font-family:宋体; font-size:12pt"> </span><span
                        style="font-family:宋体; font-size:12pt">至</span><span
                        style="font-family:宋体; font-size:12pt">      </span><span
                        style="font-family:宋体; font-size:12pt">年</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">月</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">日</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">时</span></p></td>
        </tr>
        <tr style="height:24pt">
            <td colspan="2"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:57.6pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">代履行人</span></p></td>
            <td colspan="4"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:349.2pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
        </tr>
        <tr style="height:173.9pt">
            <td colspan="2"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:57.6pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">代</span><span
                        style="font-family:宋体; font-size:12pt"> </span><span
                        style="font-family:宋体; font-size:12pt">履</span><span
                        style="font-family:宋体; font-size:12pt"> </span><span
                        style="font-family:宋体; font-size:12pt">行</span></p>
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p>
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">简要过程</span></p>
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p>
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:宋体; font-size:12pt">及</span><span
                        style="font-family:宋体; font-size:12pt"> </span><span
                        style="font-family:宋体; font-size:12pt">结</span><span
                        style="font-family:宋体; font-size:12pt"> </span><span
                        style="font-family:宋体; font-size:12pt">果</span></p></td>
            <td colspan="4"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:349.2pt">
                <p style="margin:0pt; orphans:0; text-align:center; widows:0"><span
                        style="font-family:仿宋_GB2312; font-size:12pt">&#xa0;</span></p></td>
        </tr>
        <tr style="height:53.25pt">
            <td colspan="6"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:417.6pt">
                <p style="margin:0pt; orphans:0; text-align:justify; text-indent:5.25pt; widows:0"><span
                        style="font-family:宋体; font-size:12pt">监督人签名：</span><span
                        style="font-family:宋体; font-size:12pt">                                            </span><span
                        style="font-family:宋体; font-size:12pt">年</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">月</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">日</span></p></td>
        </tr>
        <tr style="height:53.25pt">
            <td colspan="6"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:417.6pt">
                <p style="margin:0pt; orphans:0; text-align:justify; text-indent:5.25pt; widows:0"><span
                        style="font-family:宋体; font-size:12pt">代履行人签名：</span><span
                        style="font-family:宋体; font-size:12pt">                                          </span><span
                        style="font-family:宋体; font-size:12pt">年</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">月</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">日</span></p></td>
        </tr>
        <tr style="height:42.6pt">
            <td colspan="6"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:417.6pt">
                <p style="margin:0pt; orphans:0; text-align:justify; text-indent:5.25pt; widows:0"><span
                        style="font-family:宋体; font-size:12pt">当事人签名：</span><span
                        style="font-family:宋体; font-size:12pt">                                            </span><span
                        style="font-family:宋体; font-size:12pt">年</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">月</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">日</span></p></td>
        </tr>
        <tr style="height:53.25pt">
            <td colspan="6"
                style="border-bottom-color:#000000; border-bottom-style:solid; border-bottom-width:0.75pt; border-left-color:#000000; border-left-style:solid; border-left-width:0.75pt; border-right-color:#000000; border-right-style:solid; border-right-width:0.75pt; border-top-color:#000000; border-top-style:solid; border-top-width:0.75pt; padding-left:5.03pt; padding-right:5.03pt; vertical-align:middle; width:417.6pt">
                <p style="margin:0pt; orphans:0; text-align:justify; text-indent:5.25pt; widows:0"><span
                        style="font-family:宋体; font-size:12pt">见证人签名：</span><span
                        style="font-family:宋体; font-size:12pt">                                            </span><span
                        style="font-family:宋体; font-size:12pt">年</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">月</span><span
                        style="font-family:宋体; font-size:12pt">   </span><span
                        style="font-family:宋体; font-size:12pt">日</span></p></td>
        </tr>
        <tr style="height:0pt">
            <td style="width:32.3pt; border:none"></td>
            <td style="width:36.1pt; border:none"></td>
            <td style="width:54pt; border:none"></td>
            <td style="width:171pt; border:none"></td>
            <td style="width:56.8pt; border:none"></td>
            <td style="width:78.2pt; border:none"></td>
        </tr>
    </table>
    <p style="margin:0pt; orphans:0; text-align:justify; widows:0"><span style="font-family:Calibri; font-size:10.5pt">&#xa0;</span>
    </p>
    <p style="margin:0pt; orphans:0; text-align:justify; widows:0"><span style="font-family:Calibri; font-size:10.5pt">&#xa0;</span>
    </p></div>
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